Hamilton T W, Pandit H G, Maurer D G, Ostlere S J, Jenkins C, Mellon S J, Dodd C A F, Murray D W
NDORMS, University of Oxford, Oxford, UK.
University of Oxford, Oxford, UK.
Bone Joint J. 2017 May;99-B(5):632-639. doi: 10.1302/0301-620X.99B5.BJJ-2016-0695.R2.
It is not clear whether anterior knee pain and osteoarthritis (OA) of the patellofemoral joint (PFJ) are contraindications to medial unicompartmental knee arthroplasty (UKA). Our aim was to investigate the long-term outcome of a consecutive series of patients, some of whom had anterior knee pain and PFJ OA managed with UKA.
We assessed the ten-year functional outcomes and 15-year implant survival of 805 knees (677 patients) following medial mobile-bearing UKA. The intra-operative status of the PFJ was documented and, with the exception of bone loss with grooving to the lateral side, neither the clinical or radiological state of the PFJ nor the presence of anterior knee pain were considered a contraindication. The impact of radiographic findings and anterior knee pain was studied in a subgroup of 100 knees (91 patients).
There was no relationship between functional outcomes, at a mean of ten years, or 15-year implant survival, and pre-operative anterior knee pain, or the presence or degree of cartilage loss documented intra-operatively at the medial patella or trochlea, or radiographic evidence of OA in the medial side of the PFJ. In 6% of cases there was full thickness cartilage loss on the lateral side of the patella. In these cases, the overall ten-year function and 15-year survival was similar to those without cartilage loss; however they had slightly more difficulty with descending stairs. Radiographic signs of OA seen in the lateral part of the PFJ were not associated with a definite compromise in functional outcome or implant survival.
Severe damage to the lateral side of the PFJ with bone loss and grooving remains a contraindication to mobile-bearing UKA. Less severe damage to the lateral side of the PFJ and damage to the medial side, however severe, does not compromise the overall function or survival, so should not be considered to be a contraindication. However, if a patient does have full thickness cartilage loss on the lateral side of the PFJ they may have a slight compromise in their ability to descend stairs. Pre-operative anterior knee pain also does not compromise the functional outcome or survival and should not be considered to be a contraindication. Cite this article: 2017;99-B:632-9.
目前尚不清楚髌股关节（PFJ）的膝前疼痛和骨关节炎（OA）是否为内侧单髁膝关节置换术（UKA）的禁忌证。我们的目的是研究一系列连续患者的长期疗效，其中部分患者患有膝前疼痛和采用UKA治疗的PFJ OA。
我们评估了805例膝关节（677例患者）行内侧活动平台UKA术后10年的功能结局和15年的假体生存率。记录了PFJ的术中情况，除了外侧出现骨丢失伴沟槽外，PFJ的临床或放射学状态以及膝前疼痛的存在均不被视为禁忌证。在100例膝关节（91例患者）的亚组中研究了影像学表现和膝前疼痛的影响。
平均10年的功能结局或15年的假体生存率与术前膝前疼痛、术中记录的内侧髌骨或滑车软骨丢失的存在或程度，或PFJ内侧OA的放射学证据之间均无关联。6%的病例髌骨外侧存在全层软骨丢失。在这些病例中，总体10年功能和15年生存率与无软骨丢失的病例相似；然而，他们下楼梯时略有困难。PFJ外侧出现的OA放射学征象与功能结局或假体生存率的明确受损无关。
PFJ外侧伴有骨丢失和沟槽的严重损伤仍然是活动平台UKA的禁忌证。PFJ外侧较轻的损伤以及内侧的损伤，无论多么严重，均不会损害整体功能或生存率，因此不应被视为禁忌证。然而，如果患者PFJ外侧存在全层软骨丢失，他们下楼梯的能力可能会略有受损。术前膝前疼痛也不会损害功能结局或生存率，不应被视为禁忌证。引用本文：2017；99-B：632-9。
